ERENUMAB-AOOE 70 MG/ML SUBCUTANEOUS AUTO-INJECTOR [221765]
|
Facility
|
IP
|
$885.43
|
|
Service Code
|
CPT J3590
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$212.50 |
Max. Negotiated Rate |
$752.62 |
Rate for Payer: Blue Shield of California Commercial |
$630.43
|
Rate for Payer: Blue Shield of California EPN |
$453.34
|
Rate for Payer: Cash Price |
$398.44
|
Rate for Payer: Cigna of CA HMO |
$619.80
|
Rate for Payer: Cigna of CA PPO |
$619.80
|
Rate for Payer: EPIC Health Plan Commercial |
$354.17
|
Rate for Payer: EPIC Health Plan Transplant |
$354.17
|
Rate for Payer: Galaxy Health WC |
$752.62
|
Rate for Payer: Global Benefits Group Commercial |
$531.26
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$590.58
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.35
|
Rate for Payer: LLUH Dept of Risk Management WC |
$212.50
|
Rate for Payer: Multiplan Commercial |
$708.34
|
Rate for Payer: Networks By Design Commercial |
$442.72
|
Rate for Payer: Prime Health Services Commercial |
$752.62
|
Rate for Payer: United Healthcare All Other Commercial |
$334.34
|
Rate for Payer: United Healthcare All Other HMO |
$326.55
|
Rate for Payer: United Healthcare HMO Rider |
$319.46
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$292.19
|
|
ERENUMAB-AOOE 70 MG/ML SUBCUTANEOUS AUTO-INJECTOR [221765]
|
Facility
|
OP
|
$885.43
|
|
Service Code
|
CPT J3590
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$212.50 |
Max. Negotiated Rate |
$752.62 |
Rate for Payer: Aetna of CA HMO/PPO |
$580.75
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$752.62
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$486.99
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$486.99
|
Rate for Payer: Blue Distinction Transplant |
$531.26
|
Rate for Payer: Blue Shield of California Commercial |
$652.56
|
Rate for Payer: Blue Shield of California EPN |
$517.09
|
Rate for Payer: Cash Price |
$398.44
|
Rate for Payer: Cigna of CA HMO |
$619.80
|
Rate for Payer: Cigna of CA PPO |
$619.80
|
Rate for Payer: Dignity Health Commercial/Exchange |
$752.62
|
Rate for Payer: Dignity Health Media |
$752.62
|
Rate for Payer: Dignity Health Medi-Cal |
$752.62
|
Rate for Payer: EPIC Health Plan Commercial |
$354.17
|
Rate for Payer: EPIC Health Plan Transplant |
$354.17
|
Rate for Payer: Galaxy Health WC |
$752.62
|
Rate for Payer: Global Benefits Group Commercial |
$531.26
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$664.07
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$590.58
|
Rate for Payer: LLUH Dept of Risk Management WC |
$212.50
|
Rate for Payer: Multiplan Commercial |
$708.34
|
Rate for Payer: Networks By Design Commercial |
$442.72
|
Rate for Payer: Prime Health Services Commercial |
$752.62
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$531.26
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$531.26
|
Rate for Payer: United Healthcare All Other Commercial |
$442.72
|
Rate for Payer: United Healthcare All Other HMO |
$442.72
|
Rate for Payer: United Healthcare HMO Rider |
$442.72
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$442.72
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$752.62
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$752.62
|
Rate for Payer: Vantage Medical Group Senior |
$752.62
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
IP
|
$0.44
|
|
Service Code
|
NDC 69452-151-20
|
Hospital Charge Code |
1710033
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.11 |
Max. Negotiated Rate |
$0.37 |
Rate for Payer: Blue Shield of California Commercial |
$0.31
|
Rate for Payer: Blue Shield of California EPN |
$0.23
|
Rate for Payer: Cash Price |
$0.20
|
Rate for Payer: Cigna of CA HMO |
$0.31
|
Rate for Payer: Cigna of CA PPO |
$0.31
|
Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
Rate for Payer: Galaxy Health WC |
$0.37
|
Rate for Payer: Global Benefits Group Commercial |
$0.26
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
Rate for Payer: Multiplan Commercial |
$0.35
|
Rate for Payer: Networks By Design Commercial |
$0.29
|
Rate for Payer: Prime Health Services Commercial |
$0.37
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) CAPSULE [2863]
|
Facility
|
OP
|
$0.44
|
|
Service Code
|
NDC 69452-151-20
|
Hospital Charge Code |
1710033
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.11 |
Max. Negotiated Rate |
$0.37 |
Rate for Payer: Aetna of CA HMO/PPO |
$0.29
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.37
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.24
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.24
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.26
|
Rate for Payer: Blue Distinction Transplant |
$0.26
|
Rate for Payer: Blue Shield of California Commercial |
$0.32
|
Rate for Payer: Blue Shield of California EPN |
$0.26
|
Rate for Payer: Cash Price |
$0.20
|
Rate for Payer: Cigna of CA HMO |
$0.31
|
Rate for Payer: Cigna of CA PPO |
$0.31
|
Rate for Payer: Dignity Health Commercial/Exchange |
$0.37
|
Rate for Payer: Dignity Health Media |
$0.37
|
Rate for Payer: Dignity Health Medi-Cal |
$0.37
|
Rate for Payer: EPIC Health Plan Commercial |
$0.18
|
Rate for Payer: EPIC Health Plan Transplant |
$0.18
|
Rate for Payer: Galaxy Health WC |
$0.37
|
Rate for Payer: Global Benefits Group Commercial |
$0.26
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.33
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.29
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.17
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
Rate for Payer: Multiplan Commercial |
$0.35
|
Rate for Payer: Networks By Design Commercial |
$0.29
|
Rate for Payer: Prime Health Services Commercial |
$0.37
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.26
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.26
|
Rate for Payer: United Healthcare All Other Commercial |
$0.22
|
Rate for Payer: United Healthcare All Other HMO |
$0.22
|
Rate for Payer: United Healthcare HMO Rider |
$0.22
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.22
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.37
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$0.37
|
Rate for Payer: Vantage Medical Group Senior |
$0.37
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS [9943]
|
Facility
|
IP
|
$1.66
|
|
Service Code
|
NDC 3932835760
|
Hospital Charge Code |
NDG9943
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.40 |
Max. Negotiated Rate |
$1.41 |
Rate for Payer: Blue Shield of California Commercial |
$1.18
|
Rate for Payer: Blue Shield of California EPN |
$0.85
|
Rate for Payer: Cash Price |
$0.75
|
Rate for Payer: Cigna of CA HMO |
$1.16
|
Rate for Payer: Cigna of CA PPO |
$1.16
|
Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
Rate for Payer: Galaxy Health WC |
$1.41
|
Rate for Payer: Global Benefits Group Commercial |
$1.00
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
Rate for Payer: Multiplan Commercial |
$1.33
|
Rate for Payer: Networks By Design Commercial |
$1.08
|
Rate for Payer: Prime Health Services Commercial |
$1.41
|
|
ERGOCALCIFEROL (VITAMIN D2) 200 MCG/ML (8,000 UNIT/ML) ORAL DROPS [9943]
|
Facility
|
OP
|
$1.66
|
|
Service Code
|
NDC 3932835760
|
Hospital Charge Code |
NDG9943
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$0.40 |
Max. Negotiated Rate |
$1.41 |
Rate for Payer: Aetna of CA HMO/PPO |
$1.09
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.41
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.91
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.91
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.99
|
Rate for Payer: Blue Distinction Transplant |
$1.00
|
Rate for Payer: Blue Shield of California Commercial |
$1.22
|
Rate for Payer: Blue Shield of California EPN |
$0.97
|
Rate for Payer: Cash Price |
$0.75
|
Rate for Payer: Cigna of CA HMO |
$1.16
|
Rate for Payer: Cigna of CA PPO |
$1.16
|
Rate for Payer: Dignity Health Commercial/Exchange |
$1.41
|
Rate for Payer: Dignity Health Media |
$1.41
|
Rate for Payer: Dignity Health Medi-Cal |
$1.41
|
Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
Rate for Payer: EPIC Health Plan Transplant |
$0.66
|
Rate for Payer: Galaxy Health WC |
$1.41
|
Rate for Payer: Global Benefits Group Commercial |
$1.00
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.24
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.11
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
Rate for Payer: Multiplan Commercial |
$1.33
|
Rate for Payer: Networks By Design Commercial |
$1.08
|
Rate for Payer: Prime Health Services Commercial |
$1.41
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.00
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.00
|
Rate for Payer: United Healthcare All Other Commercial |
$0.83
|
Rate for Payer: United Healthcare All Other HMO |
$0.83
|
Rate for Payer: United Healthcare HMO Rider |
$0.83
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$0.83
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.41
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$1.41
|
Rate for Payer: Vantage Medical Group Senior |
$1.41
|
|
ERGOTAMINE 1 MG-CAFFEINE 100 MG TABLET [9949]
|
Facility
|
IP
|
$14.82
|
|
Service Code
|
NDC 0781-5405-01
|
Hospital Charge Code |
1712008
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$3.56 |
Max. Negotiated Rate |
$12.60 |
Rate for Payer: Blue Shield of California Commercial |
$10.55
|
Rate for Payer: Blue Shield of California EPN |
$7.59
|
Rate for Payer: Cash Price |
$6.67
|
Rate for Payer: Cigna of CA HMO |
$10.37
|
Rate for Payer: Cigna of CA PPO |
$10.37
|
Rate for Payer: EPIC Health Plan Commercial |
$5.93
|
Rate for Payer: Galaxy Health WC |
$12.60
|
Rate for Payer: Global Benefits Group Commercial |
$8.89
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.88
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.65
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.56
|
Rate for Payer: Multiplan Commercial |
$11.86
|
Rate for Payer: Networks By Design Commercial |
$9.63
|
Rate for Payer: Prime Health Services Commercial |
$12.60
|
|
ERGOTAMINE 1 MG-CAFFEINE 100 MG TABLET [9949]
|
Facility
|
OP
|
$14.82
|
|
Service Code
|
NDC 0781-5405-01
|
Hospital Charge Code |
1712008
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$3.56 |
Max. Negotiated Rate |
$12.60 |
Rate for Payer: Aetna of CA HMO/PPO |
$9.72
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.60
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.15
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.15
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.83
|
Rate for Payer: Blue Distinction Transplant |
$8.89
|
Rate for Payer: Blue Shield of California Commercial |
$10.92
|
Rate for Payer: Blue Shield of California EPN |
$8.65
|
Rate for Payer: Cash Price |
$6.67
|
Rate for Payer: Cigna of CA HMO |
$10.37
|
Rate for Payer: Cigna of CA PPO |
$10.37
|
Rate for Payer: Dignity Health Commercial/Exchange |
$12.60
|
Rate for Payer: Dignity Health Media |
$12.60
|
Rate for Payer: Dignity Health Medi-Cal |
$12.60
|
Rate for Payer: EPIC Health Plan Commercial |
$5.93
|
Rate for Payer: EPIC Health Plan Transplant |
$5.93
|
Rate for Payer: Galaxy Health WC |
$12.60
|
Rate for Payer: Global Benefits Group Commercial |
$8.89
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.12
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.88
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.65
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.56
|
Rate for Payer: Multiplan Commercial |
$11.86
|
Rate for Payer: Networks By Design Commercial |
$9.63
|
Rate for Payer: Prime Health Services Commercial |
$12.60
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.89
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.89
|
Rate for Payer: United Healthcare All Other Commercial |
$7.41
|
Rate for Payer: United Healthcare All Other HMO |
$7.41
|
Rate for Payer: United Healthcare HMO Rider |
$7.41
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$7.41
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.60
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$12.60
|
Rate for Payer: Vantage Medical Group Senior |
$12.60
|
|
ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION [106773]
|
Facility
|
OP
|
$820.80
|
|
Service Code
|
CPT J9179
|
Hospital Charge Code |
1755763
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$134.02 |
Max. Negotiated Rate |
$842.91 |
Rate for Payer: Aetna of CA HMO/PPO |
$842.91
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.52
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.42
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.42
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.78
|
Rate for Payer: Blue Distinction Transplant |
$492.48
|
Rate for Payer: Blue Shield of California Commercial |
$604.93
|
Rate for Payer: Blue Shield of California EPN |
$141.60
|
Rate for Payer: Cash Price |
$369.36
|
Rate for Payer: Cash Price |
$369.36
|
Rate for Payer: Cigna of CA HMO |
$574.56
|
Rate for Payer: Cigna of CA PPO |
$574.56
|
Rate for Payer: Dignity Health Commercial/Exchange |
$201.03
|
Rate for Payer: Dignity Health Media |
$134.02
|
Rate for Payer: Dignity Health Medi-Cal |
$147.42
|
Rate for Payer: EPIC Health Plan Commercial |
$180.92
|
Rate for Payer: EPIC Health Plan Medicare/Senior |
$134.02
|
Rate for Payer: EPIC Health Plan Transplant |
$134.02
|
Rate for Payer: Galaxy Health WC |
$697.68
|
Rate for Payer: Global Benefits Group Commercial |
$492.48
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$615.60
|
Rate for Payer: Heritage Provider Network Commercial |
$219.79
|
Rate for Payer: Heritage Provider Network Transplant |
$219.79
|
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$217.11
|
Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$217.11
|
Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.02
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.47
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.11
|
Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.02
|
Rate for Payer: LLUH Dept of Risk Management WC |
$196.99
|
Rate for Payer: Molina Healthcare of CA Medi-Cal |
$168.86
|
Rate for Payer: Molina Healthcare of CA Medicare |
$179.58
|
Rate for Payer: Multiplan Commercial |
$656.64
|
Rate for Payer: Networks By Design Commercial |
$410.40
|
Rate for Payer: Prime Health Services Commercial |
$697.68
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$492.48
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$492.48
|
Rate for Payer: United Healthcare All Other Commercial |
$410.40
|
Rate for Payer: United Healthcare All Other HMO |
$410.40
|
Rate for Payer: United Healthcare HMO Rider |
$410.40
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$410.40
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.03
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$147.42
|
Rate for Payer: Vantage Medical Group Senior |
$134.02
|
|
ERIBULIN 1 MG/2 ML (0.5 MG/ML) INTRAVENOUS SOLUTION [106773]
|
Facility
|
IP
|
$820.80
|
|
Service Code
|
CPT J9179
|
Hospital Charge Code |
1755763
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$196.99 |
Max. Negotiated Rate |
$697.68 |
Rate for Payer: Blue Shield of California Commercial |
$584.41
|
Rate for Payer: Blue Shield of California EPN |
$420.25
|
Rate for Payer: Cash Price |
$369.36
|
Rate for Payer: Cigna of CA HMO |
$574.56
|
Rate for Payer: Cigna of CA PPO |
$574.56
|
Rate for Payer: EPIC Health Plan Commercial |
$328.32
|
Rate for Payer: EPIC Health Plan Transplant |
$328.32
|
Rate for Payer: Galaxy Health WC |
$697.68
|
Rate for Payer: Global Benefits Group Commercial |
$492.48
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.47
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.72
|
Rate for Payer: LLUH Dept of Risk Management WC |
$196.99
|
Rate for Payer: Multiplan Commercial |
$656.64
|
Rate for Payer: Networks By Design Commercial |
$410.40
|
Rate for Payer: Prime Health Services Commercial |
$697.68
|
Rate for Payer: United Healthcare All Other Commercial |
$309.93
|
Rate for Payer: United Healthcare All Other HMO |
$302.71
|
Rate for Payer: United Healthcare HMO Rider |
$296.14
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$270.86
|
|
ERTAPENEM 1 GRAM INJECTION (IM) [4083192201]
|
Facility
|
OP
|
$140.48
|
|
Service Code
|
CPT J1335
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$33.12 |
Max. Negotiated Rate |
$119.41 |
Rate for Payer: Aetna of CA HMO/PPO |
$81.51
|
Rate for Payer: Aetna of CA HMO/PPO |
$81.51
|
Rate for Payer: Aetna of CA HMO/PPO |
$81.51
|
Rate for Payer: Aetna of CA HMO/PPO |
$81.51
|
Rate for Payer: Aetna of CA HMO/PPO |
$81.51
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$131.23
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.45
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.41
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.58
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.91
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.35
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.26
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.61
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.91
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.35
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.26
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.00
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$91.61
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.48
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.48
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.48
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.48
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.48
|
Rate for Payer: Blue Distinction Transplant |
$92.63
|
Rate for Payer: Blue Distinction Transplant |
$84.29
|
Rate for Payer: Blue Distinction Transplant |
$72.00
|
Rate for Payer: Blue Distinction Transplant |
$34.20
|
Rate for Payer: Blue Distinction Transplant |
$99.94
|
Rate for Payer: Blue Shield of California Commercial |
$42.01
|
Rate for Payer: Blue Shield of California Commercial |
$113.79
|
Rate for Payer: Blue Shield of California Commercial |
$88.44
|
Rate for Payer: Blue Shield of California Commercial |
$122.75
|
Rate for Payer: Blue Shield of California Commercial |
$103.53
|
Rate for Payer: Blue Shield of California EPN |
$70.24
|
Rate for Payer: Blue Shield of California EPN |
$70.24
|
Rate for Payer: Blue Shield of California EPN |
$70.24
|
Rate for Payer: Blue Shield of California EPN |
$70.24
|
Rate for Payer: Blue Shield of California EPN |
$70.24
|
Rate for Payer: Cash Price |
$69.48
|
Rate for Payer: Cash Price |
$63.22
|
Rate for Payer: Cash Price |
$63.22
|
Rate for Payer: Cash Price |
$54.00
|
Rate for Payer: Cash Price |
$54.00
|
Rate for Payer: Cash Price |
$25.65
|
Rate for Payer: Cash Price |
$25.65
|
Rate for Payer: Cash Price |
$74.95
|
Rate for Payer: Cash Price |
$74.95
|
Rate for Payer: Cash Price |
$69.48
|
Rate for Payer: Cigna of CA HMO |
$116.59
|
Rate for Payer: Cigna of CA HMO |
$84.00
|
Rate for Payer: Cigna of CA HMO |
$98.34
|
Rate for Payer: Cigna of CA HMO |
$39.90
|
Rate for Payer: Cigna of CA HMO |
$108.07
|
Rate for Payer: Cigna of CA PPO |
$98.34
|
Rate for Payer: Cigna of CA PPO |
$116.59
|
Rate for Payer: Cigna of CA PPO |
$39.90
|
Rate for Payer: Cigna of CA PPO |
$84.00
|
Rate for Payer: Cigna of CA PPO |
$108.07
|
Rate for Payer: Dignity Health Commercial/Exchange |
$119.41
|
Rate for Payer: Dignity Health Commercial/Exchange |
$131.23
|
Rate for Payer: Dignity Health Commercial/Exchange |
$48.45
|
Rate for Payer: Dignity Health Commercial/Exchange |
$141.58
|
Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
Rate for Payer: Dignity Health Media |
$102.00
|
Rate for Payer: Dignity Health Media |
$141.58
|
Rate for Payer: Dignity Health Media |
$48.45
|
Rate for Payer: Dignity Health Media |
$119.41
|
Rate for Payer: Dignity Health Media |
$131.23
|
Rate for Payer: Dignity Health Medi-Cal |
$131.23
|
Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
Rate for Payer: Dignity Health Medi-Cal |
$119.41
|
Rate for Payer: Dignity Health Medi-Cal |
$48.45
|
Rate for Payer: Dignity Health Medi-Cal |
$141.58
|
Rate for Payer: EPIC Health Plan Commercial |
$56.19
|
Rate for Payer: EPIC Health Plan Commercial |
$61.76
|
Rate for Payer: EPIC Health Plan Commercial |
$66.62
|
Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
Rate for Payer: EPIC Health Plan Transplant |
$61.76
|
Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
Rate for Payer: EPIC Health Plan Transplant |
$56.19
|
Rate for Payer: EPIC Health Plan Transplant |
$66.62
|
Rate for Payer: EPIC Health Plan Transplant |
$22.80
|
Rate for Payer: Galaxy Health WC |
$119.41
|
Rate for Payer: Galaxy Health WC |
$48.45
|
Rate for Payer: Galaxy Health WC |
$131.23
|
Rate for Payer: Galaxy Health WC |
$102.00
|
Rate for Payer: Galaxy Health WC |
$141.58
|
Rate for Payer: Global Benefits Group Commercial |
$99.94
|
Rate for Payer: Global Benefits Group Commercial |
$92.63
|
Rate for Payer: Global Benefits Group Commercial |
$34.20
|
Rate for Payer: Global Benefits Group Commercial |
$72.00
|
Rate for Payer: Global Benefits Group Commercial |
$84.29
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$124.92
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42.75
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$90.00
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$115.79
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$105.36
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.10
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.70
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.98
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.12
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.12
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.12
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.12
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$39.97
|
Rate for Payer: LLUH Dept of Risk Management WC |
$37.05
|
Rate for Payer: LLUH Dept of Risk Management WC |
$33.72
|
Rate for Payer: LLUH Dept of Risk Management WC |
$13.68
|
Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
Rate for Payer: Multiplan Commercial |
$96.00
|
Rate for Payer: Multiplan Commercial |
$123.51
|
Rate for Payer: Multiplan Commercial |
$112.38
|
Rate for Payer: Multiplan Commercial |
$45.60
|
Rate for Payer: Multiplan Commercial |
$133.25
|
Rate for Payer: Networks By Design Commercial |
$28.50
|
Rate for Payer: Networks By Design Commercial |
$77.20
|
Rate for Payer: Networks By Design Commercial |
$83.28
|
Rate for Payer: Networks By Design Commercial |
$60.00
|
Rate for Payer: Networks By Design Commercial |
$70.24
|
Rate for Payer: Prime Health Services Commercial |
$141.58
|
Rate for Payer: Prime Health Services Commercial |
$131.23
|
Rate for Payer: Prime Health Services Commercial |
$102.00
|
Rate for Payer: Prime Health Services Commercial |
$119.41
|
Rate for Payer: Prime Health Services Commercial |
$48.45
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.94
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.63
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.20
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.29
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.63
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.29
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.94
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
Rate for Payer: United Healthcare All Other Commercial |
$70.24
|
Rate for Payer: United Healthcare All Other Commercial |
$28.50
|
Rate for Payer: United Healthcare All Other Commercial |
$83.28
|
Rate for Payer: United Healthcare All Other Commercial |
$77.20
|
Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
Rate for Payer: United Healthcare All Other HMO |
$60.00
|
Rate for Payer: United Healthcare All Other HMO |
$77.20
|
Rate for Payer: United Healthcare All Other HMO |
$70.24
|
Rate for Payer: United Healthcare All Other HMO |
$83.28
|
Rate for Payer: United Healthcare All Other HMO |
$28.50
|
Rate for Payer: United Healthcare HMO Rider |
$60.00
|
Rate for Payer: United Healthcare HMO Rider |
$83.28
|
Rate for Payer: United Healthcare HMO Rider |
$28.50
|
Rate for Payer: United Healthcare HMO Rider |
$77.20
|
Rate for Payer: United Healthcare HMO Rider |
$70.24
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$70.24
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$83.28
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$77.20
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$28.50
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$131.23
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$141.58
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.45
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.41
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$48.45
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$131.23
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$141.58
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$119.41
|
Rate for Payer: Vantage Medical Group Senior |
$48.45
|
Rate for Payer: Vantage Medical Group Senior |
$141.58
|
Rate for Payer: Vantage Medical Group Senior |
$119.41
|
Rate for Payer: Vantage Medical Group Senior |
$131.23
|
Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
ERTAPENEM 1 GRAM INJECTION (IM) [4083192201]
|
Facility
|
IP
|
$120.00
|
|
Service Code
|
CPT J1335
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$28.80 |
Max. Negotiated Rate |
$102.00 |
Rate for Payer: Blue Shield of California Commercial |
$85.44
|
Rate for Payer: Blue Shield of California Commercial |
$118.59
|
Rate for Payer: Blue Shield of California Commercial |
$40.58
|
Rate for Payer: Blue Shield of California Commercial |
$100.02
|
Rate for Payer: Blue Shield of California Commercial |
$109.93
|
Rate for Payer: Blue Shield of California EPN |
$71.93
|
Rate for Payer: Blue Shield of California EPN |
$79.05
|
Rate for Payer: Blue Shield of California EPN |
$61.44
|
Rate for Payer: Blue Shield of California EPN |
$29.18
|
Rate for Payer: Blue Shield of California EPN |
$85.28
|
Rate for Payer: Cash Price |
$25.65
|
Rate for Payer: Cash Price |
$69.48
|
Rate for Payer: Cash Price |
$54.00
|
Rate for Payer: Cash Price |
$74.95
|
Rate for Payer: Cash Price |
$63.22
|
Rate for Payer: Cigna of CA HMO |
$39.90
|
Rate for Payer: Cigna of CA HMO |
$98.34
|
Rate for Payer: Cigna of CA HMO |
$108.07
|
Rate for Payer: Cigna of CA HMO |
$116.59
|
Rate for Payer: Cigna of CA HMO |
$84.00
|
Rate for Payer: Cigna of CA PPO |
$39.90
|
Rate for Payer: Cigna of CA PPO |
$98.34
|
Rate for Payer: Cigna of CA PPO |
$108.07
|
Rate for Payer: Cigna of CA PPO |
$116.59
|
Rate for Payer: Cigna of CA PPO |
$84.00
|
Rate for Payer: EPIC Health Plan Commercial |
$66.62
|
Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
Rate for Payer: EPIC Health Plan Commercial |
$56.19
|
Rate for Payer: EPIC Health Plan Commercial |
$61.76
|
Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
Rate for Payer: EPIC Health Plan Transplant |
$22.80
|
Rate for Payer: EPIC Health Plan Transplant |
$66.62
|
Rate for Payer: EPIC Health Plan Transplant |
$56.19
|
Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
Rate for Payer: EPIC Health Plan Transplant |
$61.76
|
Rate for Payer: Galaxy Health WC |
$48.45
|
Rate for Payer: Galaxy Health WC |
$119.41
|
Rate for Payer: Galaxy Health WC |
$141.58
|
Rate for Payer: Galaxy Health WC |
$131.23
|
Rate for Payer: Galaxy Health WC |
$102.00
|
Rate for Payer: Global Benefits Group Commercial |
$34.20
|
Rate for Payer: Global Benefits Group Commercial |
$99.94
|
Rate for Payer: Global Benefits Group Commercial |
$92.63
|
Rate for Payer: Global Benefits Group Commercial |
$84.29
|
Rate for Payer: Global Benefits Group Commercial |
$72.00
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.70
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.98
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.10
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.82
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.46
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.72
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.52
|
Rate for Payer: LLUH Dept of Risk Management WC |
$39.97
|
Rate for Payer: LLUH Dept of Risk Management WC |
$37.05
|
Rate for Payer: LLUH Dept of Risk Management WC |
$33.72
|
Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
Rate for Payer: LLUH Dept of Risk Management WC |
$13.68
|
Rate for Payer: Multiplan Commercial |
$45.60
|
Rate for Payer: Multiplan Commercial |
$123.51
|
Rate for Payer: Multiplan Commercial |
$112.38
|
Rate for Payer: Multiplan Commercial |
$133.25
|
Rate for Payer: Multiplan Commercial |
$96.00
|
Rate for Payer: Networks By Design Commercial |
$70.24
|
Rate for Payer: Networks By Design Commercial |
$77.20
|
Rate for Payer: Networks By Design Commercial |
$60.00
|
Rate for Payer: Networks By Design Commercial |
$83.28
|
Rate for Payer: Networks By Design Commercial |
$28.50
|
Rate for Payer: Prime Health Services Commercial |
$141.58
|
Rate for Payer: Prime Health Services Commercial |
$131.23
|
Rate for Payer: Prime Health Services Commercial |
$102.00
|
Rate for Payer: Prime Health Services Commercial |
$119.41
|
Rate for Payer: Prime Health Services Commercial |
$48.45
|
Rate for Payer: United Healthcare All Other Commercial |
$58.30
|
Rate for Payer: United Healthcare All Other Commercial |
$21.52
|
Rate for Payer: United Healthcare All Other Commercial |
$62.89
|
Rate for Payer: United Healthcare All Other Commercial |
$45.31
|
Rate for Payer: United Healthcare All Other Commercial |
$53.05
|
Rate for Payer: United Healthcare All Other HMO |
$51.81
|
Rate for Payer: United Healthcare All Other HMO |
$44.26
|
Rate for Payer: United Healthcare All Other HMO |
$56.94
|
Rate for Payer: United Healthcare All Other HMO |
$61.43
|
Rate for Payer: United Healthcare All Other HMO |
$21.02
|
Rate for Payer: United Healthcare HMO Rider |
$20.57
|
Rate for Payer: United Healthcare HMO Rider |
$60.09
|
Rate for Payer: United Healthcare HMO Rider |
$50.69
|
Rate for Payer: United Healthcare HMO Rider |
$43.30
|
Rate for Payer: United Healthcare HMO Rider |
$55.70
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$18.81
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$46.36
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$54.96
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$39.60
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$50.95
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]
|
Facility
|
OP
|
$140.48
|
|
Service Code
|
CPT J1335
|
Hospital Charge Code |
1755709
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$33.12 |
Max. Negotiated Rate |
$119.41 |
Rate for Payer: Aetna of CA HMO/PPO |
$81.51
|
Rate for Payer: Aetna of CA HMO/PPO |
$81.51
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.60
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$119.41
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.26
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.80
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.26
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.48
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.48
|
Rate for Payer: Blue Distinction Transplant |
$84.29
|
Rate for Payer: Blue Distinction Transplant |
$57.60
|
Rate for Payer: Blue Shield of California Commercial |
$103.53
|
Rate for Payer: Blue Shield of California Commercial |
$70.75
|
Rate for Payer: Blue Shield of California EPN |
$70.24
|
Rate for Payer: Blue Shield of California EPN |
$70.24
|
Rate for Payer: Cash Price |
$43.20
|
Rate for Payer: Cash Price |
$43.20
|
Rate for Payer: Cash Price |
$63.22
|
Rate for Payer: Cash Price |
$63.22
|
Rate for Payer: Cigna of CA HMO |
$98.34
|
Rate for Payer: Cigna of CA HMO |
$67.20
|
Rate for Payer: Cigna of CA PPO |
$98.34
|
Rate for Payer: Cigna of CA PPO |
$67.20
|
Rate for Payer: Dignity Health Commercial/Exchange |
$81.60
|
Rate for Payer: Dignity Health Commercial/Exchange |
$119.41
|
Rate for Payer: Dignity Health Media |
$81.60
|
Rate for Payer: Dignity Health Media |
$119.41
|
Rate for Payer: Dignity Health Medi-Cal |
$119.41
|
Rate for Payer: Dignity Health Medi-Cal |
$81.60
|
Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
Rate for Payer: EPIC Health Plan Commercial |
$56.19
|
Rate for Payer: EPIC Health Plan Transplant |
$56.19
|
Rate for Payer: EPIC Health Plan Transplant |
$38.40
|
Rate for Payer: Galaxy Health WC |
$119.41
|
Rate for Payer: Galaxy Health WC |
$81.60
|
Rate for Payer: Global Benefits Group Commercial |
$57.60
|
Rate for Payer: Global Benefits Group Commercial |
$84.29
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$72.00
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$105.36
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.70
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.12
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.12
|
Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
Rate for Payer: LLUH Dept of Risk Management WC |
$33.72
|
Rate for Payer: Multiplan Commercial |
$76.80
|
Rate for Payer: Multiplan Commercial |
$112.38
|
Rate for Payer: Networks By Design Commercial |
$70.24
|
Rate for Payer: Networks By Design Commercial |
$48.00
|
Rate for Payer: Prime Health Services Commercial |
$81.60
|
Rate for Payer: Prime Health Services Commercial |
$119.41
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.29
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.29
|
Rate for Payer: United Healthcare All Other Commercial |
$70.24
|
Rate for Payer: United Healthcare All Other Commercial |
$48.00
|
Rate for Payer: United Healthcare All Other HMO |
$48.00
|
Rate for Payer: United Healthcare All Other HMO |
$70.24
|
Rate for Payer: United Healthcare HMO Rider |
$48.00
|
Rate for Payer: United Healthcare HMO Rider |
$70.24
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$70.24
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$48.00
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$119.41
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.60
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$119.41
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$81.60
|
Rate for Payer: Vantage Medical Group Senior |
$81.60
|
Rate for Payer: Vantage Medical Group Senior |
$119.41
|
|
ERTAPENEM 1 GRAM SOLUTION FOR INJECTION [31922]
|
Facility
|
IP
|
$140.48
|
|
Service Code
|
CPT J1335
|
Hospital Charge Code |
1755709
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$33.72 |
Max. Negotiated Rate |
$119.41 |
Rate for Payer: Blue Shield of California Commercial |
$100.02
|
Rate for Payer: Blue Shield of California Commercial |
$68.35
|
Rate for Payer: Blue Shield of California EPN |
$71.93
|
Rate for Payer: Blue Shield of California EPN |
$49.15
|
Rate for Payer: Cash Price |
$63.22
|
Rate for Payer: Cash Price |
$43.20
|
Rate for Payer: Cigna of CA HMO |
$98.34
|
Rate for Payer: Cigna of CA HMO |
$67.20
|
Rate for Payer: Cigna of CA PPO |
$67.20
|
Rate for Payer: Cigna of CA PPO |
$98.34
|
Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
Rate for Payer: EPIC Health Plan Commercial |
$56.19
|
Rate for Payer: EPIC Health Plan Transplant |
$56.19
|
Rate for Payer: EPIC Health Plan Transplant |
$38.40
|
Rate for Payer: Galaxy Health WC |
$119.41
|
Rate for Payer: Galaxy Health WC |
$81.60
|
Rate for Payer: Global Benefits Group Commercial |
$57.60
|
Rate for Payer: Global Benefits Group Commercial |
$84.29
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.70
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.52
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.58
|
Rate for Payer: LLUH Dept of Risk Management WC |
$33.72
|
Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
Rate for Payer: Multiplan Commercial |
$112.38
|
Rate for Payer: Multiplan Commercial |
$76.80
|
Rate for Payer: Networks By Design Commercial |
$70.24
|
Rate for Payer: Networks By Design Commercial |
$48.00
|
Rate for Payer: Prime Health Services Commercial |
$119.41
|
Rate for Payer: Prime Health Services Commercial |
$81.60
|
Rate for Payer: United Healthcare All Other Commercial |
$53.05
|
Rate for Payer: United Healthcare All Other Commercial |
$36.25
|
Rate for Payer: United Healthcare All Other HMO |
$51.81
|
Rate for Payer: United Healthcare All Other HMO |
$35.40
|
Rate for Payer: United Healthcare HMO Rider |
$50.69
|
Rate for Payer: United Healthcare HMO Rider |
$34.64
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$46.36
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$31.68
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
OP
|
$6.75
|
|
Service Code
|
NDC 75834-242-30
|
Hospital Charge Code |
1710431
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.62 |
Max. Negotiated Rate |
$5.74 |
Rate for Payer: Aetna of CA HMO/PPO |
$4.43
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.74
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.71
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.71
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.02
|
Rate for Payer: Blue Distinction Transplant |
$4.05
|
Rate for Payer: Blue Shield of California Commercial |
$4.97
|
Rate for Payer: Blue Shield of California EPN |
$3.94
|
Rate for Payer: Cash Price |
$3.04
|
Rate for Payer: Cigna of CA HMO |
$4.72
|
Rate for Payer: Cigna of CA PPO |
$4.72
|
Rate for Payer: Dignity Health Commercial/Exchange |
$5.74
|
Rate for Payer: Dignity Health Media |
$5.74
|
Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
Rate for Payer: EPIC Health Plan Commercial |
$2.70
|
Rate for Payer: EPIC Health Plan Transplant |
$2.70
|
Rate for Payer: Galaxy Health WC |
$5.74
|
Rate for Payer: Global Benefits Group Commercial |
$4.05
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5.06
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.50
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.57
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
Rate for Payer: Multiplan Commercial |
$5.40
|
Rate for Payer: Networks By Design Commercial |
$4.39
|
Rate for Payer: Prime Health Services Commercial |
$5.74
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.05
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.05
|
Rate for Payer: United Healthcare All Other Commercial |
$3.38
|
Rate for Payer: United Healthcare All Other HMO |
$3.38
|
Rate for Payer: United Healthcare HMO Rider |
$3.38
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$3.38
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.74
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
Rate for Payer: Vantage Medical Group Senior |
$5.74
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
OP
|
$12.70
|
|
Service Code
|
NDC 69238-1484-3
|
Hospital Charge Code |
1710431
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$3.05 |
Max. Negotiated Rate |
$10.80 |
Rate for Payer: Aetna of CA HMO/PPO |
$8.33
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.80
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.98
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.98
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.57
|
Rate for Payer: Blue Distinction Transplant |
$7.62
|
Rate for Payer: Blue Shield of California Commercial |
$9.36
|
Rate for Payer: Blue Shield of California EPN |
$7.42
|
Rate for Payer: Cash Price |
$5.72
|
Rate for Payer: Cigna of CA HMO |
$8.89
|
Rate for Payer: Cigna of CA PPO |
$8.89
|
Rate for Payer: Dignity Health Commercial/Exchange |
$10.80
|
Rate for Payer: Dignity Health Media |
$10.80
|
Rate for Payer: Dignity Health Medi-Cal |
$10.80
|
Rate for Payer: EPIC Health Plan Commercial |
$5.08
|
Rate for Payer: EPIC Health Plan Transplant |
$5.08
|
Rate for Payer: Galaxy Health WC |
$10.80
|
Rate for Payer: Global Benefits Group Commercial |
$7.62
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.52
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.47
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.84
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.05
|
Rate for Payer: Multiplan Commercial |
$10.16
|
Rate for Payer: Networks By Design Commercial |
$8.26
|
Rate for Payer: Prime Health Services Commercial |
$10.80
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.62
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.62
|
Rate for Payer: United Healthcare All Other Commercial |
$6.35
|
Rate for Payer: United Healthcare All Other HMO |
$6.35
|
Rate for Payer: United Healthcare HMO Rider |
$6.35
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$6.35
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.80
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$10.80
|
Rate for Payer: Vantage Medical Group Senior |
$10.80
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
IP
|
$13.93
|
|
Service Code
|
NDC 24338-102-13
|
Hospital Charge Code |
1710431
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$3.34 |
Max. Negotiated Rate |
$11.84 |
Rate for Payer: Blue Shield of California Commercial |
$9.92
|
Rate for Payer: Blue Shield of California EPN |
$7.13
|
Rate for Payer: Cash Price |
$6.27
|
Rate for Payer: Cigna of CA HMO |
$9.75
|
Rate for Payer: Cigna of CA PPO |
$9.75
|
Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
Rate for Payer: Galaxy Health WC |
$11.84
|
Rate for Payer: Global Benefits Group Commercial |
$8.36
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.29
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.31
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.34
|
Rate for Payer: Multiplan Commercial |
$11.14
|
Rate for Payer: Networks By Design Commercial |
$9.05
|
Rate for Payer: Prime Health Services Commercial |
$11.84
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
IP
|
$7.94
|
|
Service Code
|
NDC 0093-5571-56
|
Hospital Charge Code |
1710431
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.91 |
Max. Negotiated Rate |
$6.75 |
Rate for Payer: Blue Shield of California Commercial |
$5.65
|
Rate for Payer: Blue Shield of California EPN |
$4.07
|
Rate for Payer: Cash Price |
$3.57
|
Rate for Payer: Cigna of CA HMO |
$5.56
|
Rate for Payer: Cigna of CA PPO |
$5.56
|
Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
Rate for Payer: Galaxy Health WC |
$6.75
|
Rate for Payer: Global Benefits Group Commercial |
$4.76
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
Rate for Payer: Multiplan Commercial |
$6.35
|
Rate for Payer: Networks By Design Commercial |
$5.16
|
Rate for Payer: Prime Health Services Commercial |
$6.75
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
IP
|
$11.28
|
|
Service Code
|
NDC 52536-103-03
|
Hospital Charge Code |
1710431
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$2.71 |
Max. Negotiated Rate |
$9.59 |
Rate for Payer: Blue Shield of California Commercial |
$8.03
|
Rate for Payer: Blue Shield of California EPN |
$5.78
|
Rate for Payer: Cash Price |
$5.08
|
Rate for Payer: Cigna of CA HMO |
$7.90
|
Rate for Payer: Cigna of CA PPO |
$7.90
|
Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
Rate for Payer: Galaxy Health WC |
$9.59
|
Rate for Payer: Global Benefits Group Commercial |
$6.77
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.52
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.30
|
Rate for Payer: LLUH Dept of Risk Management WC |
$2.71
|
Rate for Payer: Multiplan Commercial |
$9.02
|
Rate for Payer: Networks By Design Commercial |
$7.33
|
Rate for Payer: Prime Health Services Commercial |
$9.59
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
OP
|
$11.28
|
|
Service Code
|
NDC 52536-103-13
|
Hospital Charge Code |
1710431
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$2.71 |
Max. Negotiated Rate |
$9.59 |
Rate for Payer: Aetna of CA HMO/PPO |
$7.40
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.59
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.20
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.20
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.72
|
Rate for Payer: Blue Distinction Transplant |
$6.77
|
Rate for Payer: Blue Shield of California Commercial |
$8.31
|
Rate for Payer: Blue Shield of California EPN |
$6.59
|
Rate for Payer: Cash Price |
$5.08
|
Rate for Payer: Cigna of CA HMO |
$7.90
|
Rate for Payer: Cigna of CA PPO |
$7.90
|
Rate for Payer: Dignity Health Commercial/Exchange |
$9.59
|
Rate for Payer: Dignity Health Media |
$9.59
|
Rate for Payer: Dignity Health Medi-Cal |
$9.59
|
Rate for Payer: EPIC Health Plan Commercial |
$4.51
|
Rate for Payer: EPIC Health Plan Transplant |
$4.51
|
Rate for Payer: Galaxy Health WC |
$9.59
|
Rate for Payer: Global Benefits Group Commercial |
$6.77
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.46
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.52
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.30
|
Rate for Payer: LLUH Dept of Risk Management WC |
$2.71
|
Rate for Payer: Multiplan Commercial |
$9.02
|
Rate for Payer: Networks By Design Commercial |
$7.33
|
Rate for Payer: Prime Health Services Commercial |
$9.59
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.77
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.77
|
Rate for Payer: United Healthcare All Other Commercial |
$5.64
|
Rate for Payer: United Healthcare All Other HMO |
$5.64
|
Rate for Payer: United Healthcare HMO Rider |
$5.64
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$5.64
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.59
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$9.59
|
Rate for Payer: Vantage Medical Group Senior |
$9.59
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
OP
|
$13.93
|
|
Service Code
|
NDC 24338-102-13
|
Hospital Charge Code |
1710431
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$3.34 |
Max. Negotiated Rate |
$11.84 |
Rate for Payer: Aetna of CA HMO/PPO |
$9.14
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.84
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.66
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.66
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.30
|
Rate for Payer: Blue Distinction Transplant |
$8.36
|
Rate for Payer: Blue Shield of California Commercial |
$10.27
|
Rate for Payer: Blue Shield of California EPN |
$8.14
|
Rate for Payer: Cash Price |
$6.27
|
Rate for Payer: Cigna of CA HMO |
$9.75
|
Rate for Payer: Cigna of CA PPO |
$9.75
|
Rate for Payer: Dignity Health Commercial/Exchange |
$11.84
|
Rate for Payer: Dignity Health Media |
$11.84
|
Rate for Payer: Dignity Health Medi-Cal |
$11.84
|
Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
Rate for Payer: EPIC Health Plan Transplant |
$5.57
|
Rate for Payer: Galaxy Health WC |
$11.84
|
Rate for Payer: Global Benefits Group Commercial |
$8.36
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.45
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.29
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.31
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.34
|
Rate for Payer: Multiplan Commercial |
$11.14
|
Rate for Payer: Networks By Design Commercial |
$9.05
|
Rate for Payer: Prime Health Services Commercial |
$11.84
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.36
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.36
|
Rate for Payer: United Healthcare All Other Commercial |
$6.96
|
Rate for Payer: United Healthcare All Other HMO |
$6.96
|
Rate for Payer: United Healthcare HMO Rider |
$6.96
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$6.96
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.84
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$11.84
|
Rate for Payer: Vantage Medical Group Senior |
$11.84
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
IP
|
$12.70
|
|
Service Code
|
NDC 69238-1484-3
|
Hospital Charge Code |
1710431
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$3.05 |
Max. Negotiated Rate |
$10.80 |
Rate for Payer: Blue Shield of California Commercial |
$9.04
|
Rate for Payer: Blue Shield of California EPN |
$6.50
|
Rate for Payer: Cash Price |
$5.72
|
Rate for Payer: Cigna of CA HMO |
$8.89
|
Rate for Payer: Cigna of CA PPO |
$8.89
|
Rate for Payer: EPIC Health Plan Commercial |
$5.08
|
Rate for Payer: Galaxy Health WC |
$10.80
|
Rate for Payer: Global Benefits Group Commercial |
$7.62
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.47
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.84
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.05
|
Rate for Payer: Multiplan Commercial |
$10.16
|
Rate for Payer: Networks By Design Commercial |
$8.26
|
Rate for Payer: Prime Health Services Commercial |
$10.80
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
IP
|
$6.75
|
|
Service Code
|
NDC 75834-242-30
|
Hospital Charge Code |
1710431
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$1.62 |
Max. Negotiated Rate |
$5.74 |
Rate for Payer: Blue Shield of California Commercial |
$4.81
|
Rate for Payer: Blue Shield of California EPN |
$3.46
|
Rate for Payer: Cash Price |
$3.04
|
Rate for Payer: Cigna of CA HMO |
$4.72
|
Rate for Payer: Cigna of CA PPO |
$4.72
|
Rate for Payer: EPIC Health Plan Commercial |
$2.70
|
Rate for Payer: Galaxy Health WC |
$5.74
|
Rate for Payer: Global Benefits Group Commercial |
$4.05
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.50
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.57
|
Rate for Payer: LLUH Dept of Risk Management WC |
$1.62
|
Rate for Payer: Multiplan Commercial |
$5.40
|
Rate for Payer: Networks By Design Commercial |
$4.39
|
Rate for Payer: Prime Health Services Commercial |
$5.74
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
IP
|
$13.93
|
|
Service Code
|
NDC 24338-102-03
|
Hospital Charge Code |
1710431
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$3.34 |
Max. Negotiated Rate |
$11.84 |
Rate for Payer: Blue Shield of California Commercial |
$9.92
|
Rate for Payer: Blue Shield of California EPN |
$7.13
|
Rate for Payer: Cash Price |
$6.27
|
Rate for Payer: Cigna of CA HMO |
$9.75
|
Rate for Payer: Cigna of CA PPO |
$9.75
|
Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
Rate for Payer: Galaxy Health WC |
$11.84
|
Rate for Payer: Global Benefits Group Commercial |
$8.36
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.29
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.31
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.34
|
Rate for Payer: Multiplan Commercial |
$11.14
|
Rate for Payer: Networks By Design Commercial |
$9.05
|
Rate for Payer: Prime Health Services Commercial |
$11.84
|
|
ERYTHROMYCIN 250 MG TABLET [2889]
|
Facility
|
OP
|
$13.93
|
|
Service Code
|
NDC 24338-102-03
|
Hospital Charge Code |
1710431
|
Hospital Revenue Code
|
259
|
Min. Negotiated Rate |
$3.34 |
Max. Negotiated Rate |
$11.84 |
Rate for Payer: Aetna of CA HMO/PPO |
$9.14
|
Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.84
|
Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.66
|
Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.66
|
Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.30
|
Rate for Payer: Blue Distinction Transplant |
$8.36
|
Rate for Payer: Blue Shield of California Commercial |
$10.27
|
Rate for Payer: Blue Shield of California EPN |
$8.14
|
Rate for Payer: Cash Price |
$6.27
|
Rate for Payer: Cigna of CA HMO |
$9.75
|
Rate for Payer: Cigna of CA PPO |
$9.75
|
Rate for Payer: Dignity Health Commercial/Exchange |
$11.84
|
Rate for Payer: Dignity Health Media |
$11.84
|
Rate for Payer: Dignity Health Medi-Cal |
$11.84
|
Rate for Payer: EPIC Health Plan Commercial |
$5.57
|
Rate for Payer: EPIC Health Plan Transplant |
$5.57
|
Rate for Payer: Galaxy Health WC |
$11.84
|
Rate for Payer: Global Benefits Group Commercial |
$8.36
|
Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.45
|
Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.29
|
Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.31
|
Rate for Payer: LLUH Dept of Risk Management WC |
$3.34
|
Rate for Payer: Multiplan Commercial |
$11.14
|
Rate for Payer: Networks By Design Commercial |
$9.05
|
Rate for Payer: Prime Health Services Commercial |
$11.84
|
Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.36
|
Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.36
|
Rate for Payer: United Healthcare All Other Commercial |
$6.96
|
Rate for Payer: United Healthcare All Other HMO |
$6.96
|
Rate for Payer: United Healthcare HMO Rider |
$6.96
|
Rate for Payer: United Healthcare Select/Navigate/Core |
$6.96
|
Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.84
|
Rate for Payer: Vantage Medical Group Medi-Cal |
$11.84
|
Rate for Payer: Vantage Medical Group Senior |
$11.84
|
|